Alcohol-associated liver disease in Asian Americans: the case for disaggregated analysis

Alcohol-associated liver disease (ALD) is an increasingly important contributor to liver-related morbidity and mortality in the United States, yet its burden among Asian Americans remains poorly defined. Most national datasets aggregate Asian Americans into a single racial category, obscuring important differences across East Asian, Southeast Asian, and South Asian populations. This approach reinforces assumptions that Asian Americans uniformly have low-risk alcohol use and low rates of alcohol-related disease, potentially concealing vulnerable subgroups. Emerging evidence suggests considerable heterogeneity in liver disease burden among Asian American populations. Differences in alcohol metabolism, metabolic risk profiles, and sociocultural factors may influence susceptibility to ALD. South Asian populations, in particular, have high rates of insulin resistance, central adiposity, and type 2 diabetes, conditions that may exacerbate alcohol-related liver injury even at modest levels of consumption. Cultural stigma surrounding alcohol use, concealed drinking behaviors, acculturative stress, and delayed engagement with addiction services may further contribute to underrecognition and late presentation. At the same time, provider assumptions shaped by aggregated data and the model minority stereotype may reduce opportunities for routine alcohol screening and contribute to diagnostic misclassification. Disaggregated analyses are needed to identify high-risk populations, improve surveillance, and guide equitable clinical and public health interventions. Standardized subgroup reporting, culturally responsive screening approaches, and community-engaged prevention strategies are essential to better address ALD disparities among diverse Asian American populations.